Objective: To evaluate the application of laparoscopic exploration in delayed bile leakage caused by accessory hepatic duct injury after laparoscopic cholecystectomy. Methods; We retrospectively reviewed 14 cases of delayed bile leakage who were diagnosed and treated by laparoscopic exploration from 2005 to 2012. Results: Laparoscopic exploration completed eventfully in all the 14 cases. Aberrant duct injury occurred in 4 cases and were treated by electrocoagulating the gallbladder bed and spraying medical sealant. Partial damage of accessory hepatic duct wall occurred in 8 cases and treated with hemo-lock to close the damage,T tube or ureteral catheter to drain bile duct and removed 2 months later. The previous 12 cases recovered eventfully. Accessory hepatic duct transaction occurred in 2 cases. Urethral catheter was used to drain bile duct and choledochojejunostomy or bile duct anastomosis was performed via laparotomy 2 months later. Drainage tube was placed in foramina of Winslow, Subphrenic fossa or Douglas'space in all cases. Conclusions:Since there are seriously inflammation and edema in delayed bile leakage patients caused by accessory hepatic duct injury during laparoscopic cholecystectomy, one-stage anastomosis could not performed. The laparoscopic exploration can not only deal with almost all the situations except anastomosis but also with many benefits, such as intuitive, effective, mini-invasive and with satisfactory outcomes.%目的:评价腹腔镜手术处理腹腔镜胆囊切除术(laparoscopiccholecystectomy,LC)损伤副肝管导致的迟发性胆漏的临床价值.方法:回顾分析2005 ～2012年14例患者LC术中损伤副肝管导致迟发性胆漏术后再次行腹腔镜手术的临床资料.结果:14例均顺利完成再次腹腔镜探查,其中4例迷走胆管损伤,予以电凝胆囊床、创面喷洒封闭胶后痊愈；8例副肝管管壁部分损伤,直接使用Hem-o-lok夹闭、留置T管或输尿管导管引流胆管,2个月后拔除,患者痊愈；2例副肝管横断,再次于腹腔镜下留置输尿管导管引流胆管,2个月后开腹行胆肠吻合或胆管吻合术.患者均于网膜囊孔、膈下或盆腔留置腹腔引流管.结论:LC术中损伤副肝管导致的迟发性胆漏由于腹腔内炎症水肿严重,不具备胆管一期吻合条件,再次经腹腔镜处理可完成除吻合外的操作,具有直观、有效、微创的优点,效果满意.
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